Comparing newer antipsychotic medications after older one fails
(1 March 2007: VIDYYA MEDICAL NEWS SERVICE) -- Quetiapine, and to some extent olanzapine, may be more effective than risperidone among patients who were originally taking, but had to discontinue, perphenazine—an older, first generation antipsychotic medication. However, patient responses varied considerably.
"CATIE continues to fine-tune our understanding of how our arsenal of antipsychotic medications work in real-world settings, but it also is revealing to us what questions we still must address," said NIMH Director Thomas R. Insel, M.D.
Of the 257 patients who were initially randomized to perphenazine in the CATIE study, 192 discontinued the medication for various reasons, including ineffectiveness and intolerable side effects. Among those who discontinued, 114 agreed to be re-randomized to one of three newer antipsychotic medications—olanzapine, quetiapine or risperidone.
T. Scott Stroup, M.D., MPH, of the University of North Carolina at Chapel Hill, and colleagues compared the effectiveness of the medications by determining how long patients stayed on their assigned medication. Those taking quetiapine stayed on the longest—averaging about ten months before discontinuing. Those taking olanzapine discontinued after an average of about seven months, and those taking risperidone discontinued after an average of four months.
Although the discontinuation results suggest that olanzapine was generally on par with quetiapine, patients taking olanzapine experienced more side effects. While none of those taking quetiapine discontinued use due to weight gain or metabolic side effects, 13 percent of those assigned to olanzapine discontinued it due to weight gain or metabolic problems, and 5 percent of those on risperidone did so.
"These results reinforce the fact that finding the most effective medication for each patient sometimes means trying multiple medications," said Dr. Stroup. "They remind us of the considerable variability in clinical circumstances and of our need to be responsive to an individual’s needs and preferences."
Stroup TS, et al. Effectiveness of Olanzapine, Quetiapine and Risperidone in Patients with Chronic Schizophrenia After Discontinuing Perphenazine: A CATIE Study. American Journal of Psychiatry 2007; 164:3.
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